According to Emery, the most common method by which a client can become aware of his/her thinking between sessions is the use of a thought record. Your client is asked to record dysfunctional thought forms and situations where he/she is anxious. Your client uses his/her anxiety as a cue to write out frightening thoughts. Adam said, "Thank you" to himself after pinpointing a thought; He then continued to ask himself what else was frightening him. The "Thank you" reinforced himself for identifying the thoughts. Adam was then taught to track his fears back to the original stimulus.
A thirteen-year-old client, Josh, stated he started to be anxious about the possibility of being an alcoholic. He said, "This just came out of the blue. I had no reason to be afraid." After careful questioning, he discovered that his anxiety was due to seeing an alcoholic in a movie. His anxiety stemmed from the thought, "This could happen to me," and the image of "ending up a drunk like my old man." From this experience, he learned to trace his fears back to their original stimulus or origin and then to find out how he was frightening himself.
♦ Technique: Counting Automatic Thoughts
However, as you know there are times when your client is unable to restructure his/her thoughts. When he/she cannot slow down his/her mind enough to correct them or is in a situation where he/she is unable to write them down, I then instruct the client to simply count his/her thoughts. Counting allows your client to distance himself/herself from the thoughts, giving him/her a sense of mastery over them, and helps him/her to recognize their automatic quality, rather than accepting them as an accurate reflection of external reality. Counting automatic thoughts helps the patient to see how one's thoughts produce, maintain, and intensify one's anxiety. Adam found it effective to use an inexpensive plastic counter.
Through practice, Adam learned to distance himself: "There's another fearful thought. I'll just count it and let it go." I told Adam to accept the thoughts rather than fight them. He observes his thoughts and lets them go.
♦ 4 Ways to Structure Homework Assignments
Here are four ways to make this homework assignment more structured and specific:
1. Counting specific types of anxiety-producing thoughts (such as self-doubting or catastrophic thoughts).
2. Counting thoughts in the midst of an anxiety attack, since counting may help the patient gain mastery over the situation.
3. Counting during time samples (for example, between 5 p.m. and 7 p.m.).
4. Counting at random time samples of ten minutes, using a mechanical timer.
Josh, the anxious teenager, used a digital watch with a buzzer set for certain times, which signaled him to stop what he was doing and count any threatening thought he was having. He found that this method helped to separate him from his thoughts. He said, "I now realize that my thoughts have a life of their own, and I don't have to become over-concerned with them."
However, a word of warning - make a continual assessment of the effectives to assure they are not triggering as compulsiveness.
Peer-Reviewed Journal Article References:
Hayes, J., Schimel, J., Arndt, J., & Faucher, E. H. (2010). A theoretical and empirical review of the death-thought accessibility concept in terror management research. Psychological Bulletin, 136(5), 699–739.
Vail, K. E. III, Goncy, E. A., & Edmondson, D. (2019). Anxiety buffer disruption: Worldview threat, death thought accessibility, and worldview defense among low and high posttraumatic stress symptom samples. Psychological Trauma: Theory, Research, Practice, and Policy, 11(6), 647–655.
Vail, K. E. III, Morgan, A., & Kahle, L. (2018). Self-affirmation attenuates death-thought accessibility after mortality salience, but not among a high post-traumatic stress sample. Psychological Trauma: Theory, Research, Practice, and Policy, 10(1), 112–120.
Van der Giessen, D., Colonnesi, C., & Bögels, S. M. (2019). Changes in rejection and psychological control during parent–child interactions following CBT for children’s anxiety disorder. Journal of Family Psychology, 33(7), 775–787.
Online Continuing Education QUESTION
7: What is the purpose for having your client count automatic thoughts? To
select and enter your answer go to .